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O'Driscoll MCS, Barry MME, Ryan PAG, McKenna MPB, Rowan MFE, Cleary PMS. 10-Year Clinical Review of Revision Hip Arthroplasty Following Previous Metal on Metal Hip Procedures with Preoperative Magnetic Resonance Imaging and Metal Ion Analysis: Abductor Tendon Avulsion Predicts Dislocation. J Arthroplasty 2025:S0883-5403(25)00475-9. [PMID: 40349860 DOI: 10.1016/j.arth.2025.04.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 04/29/2025] [Accepted: 04/29/2025] [Indexed: 05/14/2025] Open
Abstract
INTRODUCTION There is a paucity of long-term data following the revision of previous metal-on-metal (MoM) hip procedures. We hypothesized that functional and clinical results would be poor and that pre-revision serum ion levels and magnetic resonance imaging (MRI) findings could predict the outcome. METHODS All patients who had completed a minimum of 10 years following the revision of a MoM hip procedure at our institution were contacted. Data recorded were post-revision complication, re-revision, Oxford Hip Score, and EuroQol-5-Dimension Score, along with pre-revision serum ion levels and MRI findings. There were 56 aseptic MoM revisions from a consecutive series of 86 that reached > 10 years of follow-up. The mean age at revision surgery was 60 years (range, 31 to 75), and the mean follow-up was 138 months (range, 120 to 161). RESULTS The mean Oxford Hip Score was 37.4 and was lower in the MoM resurfacing group (mean 36.1) versus the MoM THA group (mean 38.0), P=0.46. The mean EQ-5D was 8.9. Re-revision rate was 16%, which was associated with the exchange of both components, P=0.029. The overall dislocation rate was 11%, and 5% developed infection. Preoperative MRI was available for 46 hips: abductor tendon avulsion was present in 30% and was positively associated with postoperative dislocation, P=0.043. Pseudotumor formation was present in 20%. The mean metal ion levels preoperatively were cobalt, 366.1 nmol/L, and chromium, 211.6 nmol/L, with cobalt levels above our mean value of 366.1 nmol/L associated with Goutallier grades 3/4 abductor insufficiency, P=0.033, and trending towards association with pseudotumor formation, P=0.087. CONCLUSION Satisfactory patient-reported functional outcomes are attainable at over 10 years following revision surgery for failed MoM hip surgery. However, there is a significant risk of re-revision and dislocation, which may be predicted with MRI evidence of abductor insufficiency and adverse reaction to metal debris.
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Affiliation(s)
- Mr Conor S O'Driscoll
- Royal College of Surgeons of Ireland, Dublin, Ireland; Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland.
| | - Ms Marzanne E Barry
- Royal College of Surgeons of Ireland, Dublin, Ireland; Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
| | - Prof Anthony G Ryan
- Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
| | - Mr Paul B McKenna
- Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
| | - Mr Fiachra E Rowan
- Royal College of Surgeons of Ireland, Dublin, Ireland; Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland
| | - Prof May S Cleary
- Royal College of Surgeons of Ireland, Dublin, Ireland; Department of Trauma and Orthopaedics, University Hospital Waterford, Ireland; Department of Surgery, University College Cork, Ireland
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Beshr M, Myint PK, Rankin I, Stephen C, Varma A, Farrow L. Metal-on-metal arthroplasty, cobalt toxicity, and development of cognitive impairment: a systematic review. Arch Orthop Trauma Surg 2025; 145:249. [PMID: 40244464 DOI: 10.1007/s00402-025-05869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Accepted: 04/04/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Neurological dysfunction secondary to cobalt toxicity has been described as a potential complication of metal on metal (MoM) arthroplasty, however, to date the full extent of this association remains unclear. Currently, no national guideline on the management or follow-up of MoM arthroplasty patients recommends monitoring for potential insidious cognitive decline or long term consequences. The aim of this study was to summarise the available evidence regarding the relationship between MoM arthroplasty associated cobalt toxicity and cognitive impairment (CI). METHODS A systematic review of literature describing cobalt concentrations associated with neurocognitive symptoms in patients with MoM implants was undertaken. The study was registered with PROSPERO on the 18th July 2023 (CRD42023436880), in concordance with PRISMA guidelines. The Downs and Black Checklist assessed the risk of bias and evidence quality. Primary outcomes were reports of CI and blood cobalt concentration at presentation and following revision surgery. RESULTS Of 361 records identified, 15 relevant publications were included. Downs and Black Checklist assessment revealed that few high-quality studies currently exist. A clear association between MoM arthroplasty and CI, across varied follow up periods, was described by all 15 studies. Mean serum cobalt concentrations at presentation of CI were 9.75ug- 625ug, however no threshold cobalt concentration was identified. Over 85% of papers which recorded post-revision outcomes reported partial, if not complete, resolution of pre-operative CI following revision surgery. CONCLUSIONS This study provides the first robust systematic examination of the evidence surrounding metal on metal arthroplasty, cobalt toxicity, and potential CI. While further research is required to evaluate the exact nature of this relationship, our findings suggest that national and international guidelines should highlight the possible cognitive dysfunction secondary to MoM arthroplasty associated cobalt toxicity, including the need for routine assessment of cognitive function in those who received MoM implants.
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Affiliation(s)
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | | | | | - Luke Farrow
- NHS Grampian, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Park KT, Lee DH, An JH, Won JH, Koo KH, Park JW, Lee YK. Causes of Reoperations After Primary Total Hip Arthroplasty: A Retrospective Cohort Study Over 20 Years. J Arthroplasty 2025:S0883-5403(25)00160-3. [PMID: 39956497 DOI: 10.1016/j.arth.2025.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND Reoperations following total hip arthroplasty (THA) remain a major clinical challenge, with their incidence and socioeconomic burden rising despite advances in surgical techniques and prosthesis design. This study aimed to evaluate the predominant causes of reoperations following THA over two decades at a tertiary referral hospital, comparing trends between 2004 to 2013 and 2014 to 2023. METHODS We analyzed all reoperations performed at a tertiary referral hospital between January 2004 and December 2023. A total of 515 hips (483 patients) were included after excluding multiple reoperations on the same hip. The causes of reoperation were stratified into two time periods (2004 to 2013 and 2014 to 2023) to analyze trends. The time interval from primary THA to reoperations was also evaluated. RESULTS The main cause of reoperation after primary THA was aseptic loosening, accounting for 52.4% of cases, followed by infection (13.2%), periprosthetic fracture (PPF) (10.7%), wear/osteolysis (8.5%), ceramic fracture (5.8%), and instability/dislocation (5.6%). The proportion of aseptic loosening decreased significantly from 62.5 to 40.4%, while the proportions of infection, PPF, ceramic fracture, and instability/dislocation increased (P < 0.001). The causes of reoperation varied according to the time interval. Instability, PPF, and infection were early causes, and wear/osteolysis and aseptic loosening were relatively later causes of reoperations. CONCLUSIONS Aseptic loosening was the most common cause of reoperation following primary THA. However, the proportion of infection and PPF increased as a cause of reoperations, while the proportion of aseptic loosening decreased with time. Surgeons should consider that the main cause of reoperations differed according to the time interval from primary THA to reoperation.
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Affiliation(s)
- Ki-Tae Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Hoon Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon-Hwan An
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
| | - Jong-Hwa Won
- Department of Orthopaedic Surgery, Chamjoeun Hospital, Gwangju, Gyeonggi-do, Republic of Korea
| | - Kyung-Hoi Koo
- Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, Republic of Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Murphy TA, Nandra R, Berryman F, Whitehouse MR, Dunlop DJ, Matharu GS. A comparison of postoperative microbiological and histological test results with the indication for revision as listed at the time of surgery in the National Joint Registry: a single-centre cohort study of metal-on-metal total hip replacement and hip resurfacing revision procedures. Hip Int 2024:11207000241286791. [PMID: 39632336 DOI: 10.1177/11207000241286791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
INTRODUCTION Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty (MoMHA) revision surgery align with the indication for revision listed in the NJR. METHODS NJR data for MoMHA revision patients (2004-2015) at a single centre were linked to hospital records of microbiology and histology testing for prosthetic joint infection (PJI) and adverse reaction to metal debris (ARMD). The Musculoskeletal Infection Society and Mirra classifications were used as "gold standards' to classify PJI and ARMD respectively and to assess the diagnostic accuracy of the clinician selected revision indication recorded on MDS forms. RESULTS Of 301 cases, 5.6% (n = 17) and 3.7% (n = 11) were revised for PJI and ARMD respectively. In a further 6.6% (n = 20, PJI) and 15.6% (n = 47, ARMD) the indication for revision selected at the time of surgery did not corroborate with the test results from intraoperative samples. Diagnostic accuracy analysis revealed sensitivity and specificity of indication for surgery at the time of revision for PJI of 35.5% (95% CI, 19.2-54.6) and 97.8% (CI, 54.6-95.2) respectively, and for ARMD of 7.41% (CI, 2.06-17.9) and 97.2% (CI, 94.3-98.9) respectively. CONCLUSIONS We observed that the results of histology and microbiology analyses of intraoperative samples may provide evidence to support alternative diagnoses in 20% of cases. This indicates a need for a change in the work-up of these cases to allow a more accurate prediction of the indication for revision. Alternatively, if there was evidence of a difference in outcome for patients where the indication may be changed when such data becomes available, the feasibility of a facility to add additional information from samples taken intraoperatively when it becomes available should be explored.
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Affiliation(s)
- Thomas A Murphy
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
| | | | | | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | | | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, Southmead Hospital, Bristol, UK
- The Royal Orthopaedic Hospital, Birmingham, UK
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Fernández-Torres J, Zamudio-Cuevas Y, Martínez-Flores K, López-Macay A, Rosas-Alquicira G, Martínez-Zavaleta MG, López-Jácome LE, Franco-Cendejas R, Roldan-Valadez E. β-Defensin versus conventional markers of inflammation in periprosthetic joint infection: a retrospective study. PeerJ 2024; 12:e18560. [PMID: 39575176 PMCID: PMC11580661 DOI: 10.7717/peerj.18560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 10/31/2024] [Indexed: 11/24/2024] Open
Abstract
Background Diagnosing periprosthetic joint infection (PJI) remains a significant challenge for healthcare professionals. Commonly utilized inflammatory markers include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cells (WBC). Human β-defensin 1 (β-defensin) is an antimicrobial peptide elevated in infection, yet its diagnostic value for PJI has not been explored. The purpose of this study was to evaluate the efficacy of synovial β-defensin as a diagnostic marker for PJI and to compare its performance with ESR, serum CRP, and WBC. Methods We conducted a single-center retrospective study from October 2022 to June 2023. A total of 105 joint fluid samples from revision patients at the Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra were collected intraoperatively (71 hips, 34 knees) and frozen. According to MSIS criteria, 64 patients were defined as positive for PJI and the remaining 41 were negative. Synovial β-defensin levels were quantified using ELISA, serum CRP levels by immunoturbidimetry, and blood ESR and WBC were analyzed. Sensitivity and specificity were determined using ROC curves, and diagnostic performance was compared using the area under the curve (AUC). Cut-off values for diagnosing PJI were established. Results Levels of synovial β-defensin, ESR, serum CRP, and WBC were significantly higher in the PJI group compared to the non-PJI (P < 0.0001). The AUCs were 0.948 for β-defensin, 0.884 for ESR, 0.902 for CRP, and 0.767 for WBC, with a combined AUC of 0.994. Sensitivity/specificity for β-defensin, ESR, CRP, and WBC were 0.966/0.830, 0.887/0.791, 0.930/0.771, and 0.820/0.682, respectively. Optimal predictive cut-off values were 1105.8 pg/mL for β-defensin, 11.5 mm/h for ESR, 5.55 mg/L for CRP, and 7.3 × 103/mm3 for WBC. Conclusion The synovial β-defensin assay demonstrated greater sensitivity and specificity for the diagnosis of PJI compared to ESR, serum CRP and WBC. Therefore, β-defensin shows promise as a diagnostic marker for PJI. Simultaneous determination of all markers may increase diagnostic confidence.
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Affiliation(s)
- Javier Fernández-Torres
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Mexico, Mexico
| | - Yessica Zamudio-Cuevas
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Karina Martínez-Flores
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ambar López-Macay
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Graciela Rosas-Alquicira
- Clinical Microbiology Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Luis Esaú López-Jácome
- Clinical Microbiology Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- Biomedical Research Subdirection, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- División de Investigación, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Roy A, Bennett A, Pruitt L. Feasibility of using diamond-like carbon films in total joint replacements: a review. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:47. [PMID: 39136884 PMCID: PMC11322245 DOI: 10.1007/s10856-024-06814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/16/2024] [Indexed: 08/16/2024]
Abstract
Diamond-like Carbon (DLC) has been used as a coating material of choice for a variety of technological applications owing to its favorable bio-tribo-thermo-mechanical characteristics. Here, the possibility of bringing DLC into orthopedic joint implants is examined. With ever increasing number of patients suffering from osteoarthritis as well as with the ingress of the osteoarthritic joints' malaise into younger and more active demographics, there is a pressing need to augment the performance and integrity of conventional total joint replacements (TJRs). Contemporary joint replacement devices use metal-on-polymer articulations to restore function to worn, damaged or diseased cartilage. The wear of polymeric components has been addressed using crosslinking and antioxidants; however, in the context of the metallic components, complications pertaining to corrosion and metal ion release inside the body still persist. Through this review article, we explore the use of DLC coatings on metallic bearing surfaces and elucidate why this technology might be a viable solution for ongoing electrochemical challenges in orthopedics. The different characteristics of DLC coatings and their feasibility in TJRs are examined through assessment of tribo-material characterization methods. A holistic characterization of the coating-substrate interface and the wear performance of such systems are discussed. As with all biomaterials used in TJRs, we need mindful consideration of potential in-vivo challenges. We present a few caveats for DLC coatings including delamination, hydrophobicity, and other conflicting as well as outdating findings in the literature. We recommend prudently exploring DLC films as potential coatings on metallic TJR components to solve the problems pertaining to wear, metal ion release, and corrosion. Ultimately, we advise bringing DLC into clinical use only after addressing all challenges and concerns outlined in this article.
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Affiliation(s)
- Anurag Roy
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA.
| | - Annette Bennett
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Lisa Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
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Song JH, Lim YW, Lee SW, Park HW, Jeong H, Oh S. A Very Rare Form of Ceramic Head Fracture in Bipolar Hemiarthroplasty and Total Hip Arthroplasty: Unique Experience and Literature Review. Indian J Orthop 2024; 58:447-455. [PMID: 38544532 PMCID: PMC10963705 DOI: 10.1007/s43465-024-01108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/17/2024] [Indexed: 02/23/2025]
Abstract
Introduction A fracture of the ceramic head in bipolar hemiarthroplasty using an inner polyliner has not been reported yet, and there seems to be no report of simultaneous breakage of the fourth-generation BIOLOX Delta ceramic head and liner in total hip arthroplasty. Method A 44-year-old male patient underwent bipolar hemiarthroplasty using a third-generation BIOLOX Forte ceramic head 3 years and 9 months earlier for osteonecrosis of femoral head (ONFH) and visited our hospital due to a ceramic head fracture. Conversion total hip arthroplasty was performed. A 64-year-old female patient underwent total hip arthroplasty using a fourth-generation BIOLOX Delta ceramic head and liner articulation for osteoarthritis of the hip. The ceramic head and liner were fractured during the third dislocation. Ceramic head and liner exchange revision surgery was performed. Conclusion When using ceramic bearings, fractures or delamination following trauma can occur, confirming the need to carefully evaluate the condition of the ceramic components in symptomatic patients.
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Affiliation(s)
| | | | - Se-Won Lee
- Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
| | | | - Howon Jeong
- St. Vincent’s Hospital, Suwon, Republic of Korea
| | - Seungbae Oh
- St. Vincent’s Hospital, Suwon, Republic of Korea
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Meriem S, Antoniadis A, Palazzuolo M, Wegrzyn J. The use of dual mobility cups in revision total hip arthroplasty for failed large head metal-on-metal bearings. INTERNATIONAL ORTHOPAEDICS 2024; 48:719-727. [PMID: 37907694 PMCID: PMC10901945 DOI: 10.1007/s00264-023-06017-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Revision of failed large head metal-on-metal (MoM) total hip arthroplasty (THA) is a challenging procedure particularly to reconstruct acetabular bone defect due to osteolysis and to achieve hip stability due to soft tissue damages, both potentially caused by adverse reaction to metal debris (ARMD). This study aimed to evaluate the outcome of dual mobility cup (DMC) constructs in revision THA for failed large head MoM bearings with a special attention to the occurrence of dislocation or re-revision. METHODS Between 2015 and 2019, 57 patients (64 THAs, 41 men, mean age = 65 ± 10 years) underwent revision for MoM THA with the use of DMC were prospectively included in our total joint registry. Mean time to revision was 11 ± 2.5 years. The causes for revision were adverse reaction to metal debris (ARMD) in 49 THAs (76%), painful hip with elevated blood cobalt-chromium ions in seven (11%), and acetabular aseptic loosening in eight (13%). The revision was complete in 22 THAs (34%) and acetabular only in 42 (66%). Clinical and radiographic outcomes, complications, and re-revisions were evaluated at most recent follow-up. RESULTS At mean follow-up of six ± 1.5 years, the pre- to postoperative Harris Hip Score improved from 74 ± 19 to 92 ± 4 (p = 0.004). Complications occurred in 11 cases (17%): five dislocations (8%), three periprosthetic infections (5%), two aseptic loosening of the acetabular component (3%), and two periprosthetic fractures (3%). Re-revision was required in six cases (9%). CONCLUSION The use of DMC is a reliable option to prevent instability and ensure a stable acetabular reconstruction in revision THA for failed large head MoM bearings. However, dislocation after revision remains a concern, particularly in cases of severe soft tissue damage related to ARMD.
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Affiliation(s)
- Samir Meriem
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland
| | - Alexander Antoniadis
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland.
| | - Michele Palazzuolo
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland
| | - Julien Wegrzyn
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland
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Engh CA, Bhal V, Hopper RH. Metal levels and glomerular filtration rate after unilateral Birmingham Hip Resurfacing. Bone Joint J 2024; 106-B:44-50. [PMID: 38423104 DOI: 10.1302/0301-620x.106b3.bjj-2023-0849.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims The first aim of this study was to evaluate whether preoperative renal function is associated with postoperative changes in whole blood levels of metal ions in patients who have undergone a Birmingham Hip Resurfacing (BHR) arthroplasty with a metal-on-metal bearing. The second aim was to evaluate whether exposure to increased cobalt (Co) and chromium (Cr) levels for ten years adversely affected renal function. Methods As part of a multicentre, prospective post-approval study, whole blood samples were sent to a single specialized laboratory to determine Co and Cr levels, and the estimated glomerular filtration rate (eGFR). The study included patients with 117 unrevised unilateral BHRs. There were 36 females (31%). The mean age of the patients at the time of surgery of 51.3 years (SD 6.5), and they all had preoperative one-, four-, five-, and ten-year laboratory data. The mean follow-up was 10.1 years (SD 0.2). Results Median Co levels at one year postoperatively increased significantly compared with the preoperative values, by a factor of 9.7, from 0.13 to 1.26 ppb (p < 0.001), and the median Cr levels increased significantly by a factor of 2.5, from 0.60 to 1.50 ppb (p < 0.001). Lower preoperative eGFRs were associated with significantly larger increases in Co at one year compared with the preoperative levels (ρ = -0.26; p = 0.005), but there was no relationship between preoperative eGFRs and changes in Cr at one year (ρ = -0.13; p = 0.153). Metal levels remained relatively constant with the passage of time, with a median ten-year value of 1.12 ppb for Co and 1.29 ppb for Cr. There was no significant relationship between the Co and Cr levels at ten-year follow-up and the change in eGFR from the preoperative level to that at ten years (ρ = -0.02; p = 0.827 for Co; ρ = -0.008; p = 0.933 for Cr). Conclusion Although patients with lower preoperative eGFRs tended to have larger increases in Co levels at one year, increased metal levels for patients who underwent unilateral BHR did not adversely affect renal function during the first ten postoperative years.
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Affiliation(s)
- Charles A Engh
- Anderson Orthopedic Clinic & Inova Mount Vernon Joint Replacement Center, Alexandria, Virginia, USA
| | - Vinay Bhal
- Edwards Lifesciences, Irvine, California, USA
| | - Robert H Hopper
- Anderson Orthopaedic Research Institute, Alexandria, Virginia, USA
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Heckmann ND, Chung BC, Liu KC, Chen XT, Lovro LR, Kistler NM, White E, Christ AB, Longjohn DB, Oakes DA, Lieberman JR. Metal artifact reduction sequence-MRI abnormalities in asymptomatic patients with dual-mobility hip prostheses. Bone Joint J 2024; 106-B:89-96. [PMID: 38423076 DOI: 10.1302/0301-620x.106b3.bjj-2023-0643.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims Modular dual-mobility (DM) articulations are increasingly used during total hip arthroplasty (THA). However, concerns remain regarding the metal liner modularity. This study aims to correlate metal artifact reduction sequence (MARS)-MRI abnormalities with serum metal ion levels in patients with DM articulations. Methods A total of 45 patients (50 hips) with a modular DM articulation were included with mean follow-up of 3.7 years (SD 1.2). Enrolled patients with an asymptomatic, primary THA and DM articulation with over two years' follow-up underwent MARS-MRI. Each patient had serum cobalt, chromium, and titanium levels drawn. Patient satisfaction, Oxford Hip Score, and Forgotten Joint Score-12 (FJS-12) were collected. Each MARS-MRI was independently reviewed by fellowship-trained musculoskeletal radiologists blinded to serum ion levels. Results Overall, two patients (4.4%) had abnormal periprosthetic fluid collections on MARS-MRI with cobalt levels > 3.0 μg/l. Four patients (8.9%) had MARS-MRI findings consistent with greater trochanteric bursitis, all with cobalt levels < 1.0 μg/l. A seventh patient had a periprosthetic fluid collection with normal ion levels. Of the 38 patients without MARS-MRI abnormalities, 37 (97.4%) had cobalt levels < 1.0 μg/l, while one (2.6%) had a cobalt level of 1.4 μg/l. One patient (2.2%) had a chromium level > 3.0 μg/l and a periprosthetic fluid collection. Of the 41 patients with titanium levels, five (12.2%) had titanium levels > 5.0 μg/l without associated MARS-MRI abnormalities. Conclusion Periprosthetic fluid collections associated with elevated serum cobalt levels in patients with asymptomatic DM articulations occur infrequently (4.4%), but further assessment is necessary due to implant heterogeneity.
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Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Kevin C Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Luke R Lovro
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Natalie M Kistler
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eric White
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Daniel A Oakes
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
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11
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Fernández-Torres J, Zamudio-Cuevas Y, Martínez-Flores K, Franco-Cendejas R. Relationship between biofilm-forming microorganisms (BFM: Staphylococcus aureus and Pseudomonas aeruginosa) and DEFB1 gene variants on β-defensin levels in periprosthetic joint infection (PJI). Mol Biol Rep 2024; 51:237. [PMID: 38285273 DOI: 10.1007/s11033-023-09126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/06/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between biofilm-forming microorganisms (BFM) and DEFB1 gene variants on β-defensin levels in patients with periprosthetic joint infection (PJI) of Mexican origin. METHODS AND RESULTS One hundred and five clinical aspirates were obtained from patients with suspected PJI. After microbiologic culture, samples were classified as non-septic and septic; of the latter, only those positive for Staphylococcus aureus and Pseudomonas aeruginosa were selected. β-Defensin levels were quantified by ELISA, DNA was extracted from total leukocytes of the samples, and - 20G > A (rs11362) and - 44 C > G (rs1800972) variants were genotyped using TaqMan probes. Forty-one clinical aspirates were non-septic, 18 were positive for S. aureus and 18 were positive for P. aeruginosa. It was observed that β-defensin levels were higher in the P. aeruginosa group compared to S. aureus group (2339.0 pg/mL IQR = 1809.2 vs. 1821.3 pg/mL IQR = 1536.4) and non-septic group (2339.0 pg/mL IQR = 1809.2 vs. 1099.7 pg/mL IQR = 1744.5, P < 0.001). The CG genotype of the rs1800972 variant was associated with higher β-defensin levels compared to the CC genotype for both P. aeruginosa and S. aureus (1905.8 vs. 421.7 pg/mL, P = 0.004; and 1878.2 vs. 256.4 pg/mL, P = 0.006, respectively). CONCLUSIONS Our results show that β-defensin levels are significantly elevated in patients with BFM-associated PJI compared to those without infection. Furthermore, carriers of the CG genotype of the rs1800972 variant have an increased risk of PJI. Further research is needed to replicate these findings in a larger population.
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Affiliation(s)
- Javier Fernández-Torres
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 14389, Ciudad de México, México.
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de Mexico (UNAM), 04510, Ciudad de México, México.
| | - Yessica Zamudio-Cuevas
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 14389, Ciudad de México, México
| | - Karina Martínez-Flores
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 14389, Ciudad de México, México
| | - Rafael Franco-Cendejas
- División de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 14389, Ciudad de México, México
- Subdirección de Investigación Biomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, 14389, Ciudad de México, México
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12
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Gómez-Álvarez J, Miranda I, Álvarez-Llanas A, Lisón JF, Bosch-Morell F, Doménech J. Influence of Physical Activity and Cup Orientation on Metal Ion Release and Oxidative Stress in Metal-on-Metal and Ceramic-on-Metal Total Hip Arthroplasty. J Clin Med 2024; 13:527. [PMID: 38256664 PMCID: PMC10816639 DOI: 10.3390/jcm13020527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Metal-on-metal (M-M) total hip arthroplasty (THA) has shown adverse reactions to metal debris, abnormal soft-tissue reactions, and high blood metal ion levels. This study aims to: (1) assess whether the toxicity of high levels of ions is related to altered oxidative stress and (2) evaluate tribological factors related to increased blood levels of chromium (Cr) and cobalt (Co) ions. METHODS A cross-sectional analytical descriptive study was conducted on 75 patients. A total of 25 underwent M-M THA, 25 ceramic-on-metal (C-M) THA, and 25 were on the THA waiting list. Ion metallic levels in blood, oxidative stress, physical activity, and implant position were compared. RESULTS In the M-M group, Co and Cr levels were significantly higher than those found in the C-M group and the control group (p < 0.01). We found no differences in terms of oxidative stress between the groups. Also, we did not find a correlation between metal blood levels and oxidative stress indicators, the physical activity of the patients or the position of the implants between groups. CONCLUSIONS The use of M-M bearing surfaces in THA raises the levels of metals in the blood without modifying oxidative stress regardless of the physical activity levels of the patients. Therefore, although patients with M-M bearings require close monitoring, it does not seem necessary to recommend the restriction of physical activity in patients with M-M or C-M arthroplasties.
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Affiliation(s)
- Jorge Gómez-Álvarez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Ignacio Miranda
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, 46015 Valencia, Spain
- Faculty of Health Sciences, Universidad Católica de Valencia, 46001 Valencia, Spain
| | - Alejandro Álvarez-Llanas
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, 46015 Valencia, Spain
- Faculty of Health Sciences, Universidad Católica de Valencia, 46001 Valencia, Spain
| | - Juan F. Lisón
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU Cardenal Herrera, 46115 Alfara del Patriarca, Spain; (J.F.L.); (F.B.-M.)
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Bosch-Morell
- Department of Biomedical Sciences, Faculty of Health Sciences, University CEU Cardenal Herrera, 46115 Alfara del Patriarca, Spain; (J.F.L.); (F.B.-M.)
| | - Julio Doménech
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
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13
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Keaty B, Sun Y, Didem O, Eapen J, Mathew M. Early Detection of Fretting Corrosion in Hip Replacement by Acoustic Emission Non-Invasive Technique. THIN SOLID FILMS 2024; 788:140165. [PMID: 38343423 PMCID: PMC10857833 DOI: 10.1016/j.tsf.2023.140165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Abstract
The present study aimed to investigate the feasibility of using acoustic emission (AE) as a detection method for identifying failure mechanisms at the modular junction interface in total hip replacements (THRs) subjected to fretting corrosion. The experimental setup involved simulating fretting corrosion using a Ti6Al4V disc representing the femoral neck and a ZrO2 pin representing the femoral head. Mechanical testing provided insights into the wear and frictional behavior occurring at the modular junction interface. The results revealed that for all three potential conditions, a fretting condition of partial slip was observed. These findings highlight the importance of understanding the mechanical interactions and their influence on the overall performance and longevity of THRs. Electrochemical analysis shed light on the corrosion behavior under different potentiostatic conditions. High potentials in the anodic condition led to increased corrosion and ion transfer due to the breakdown of the passive oxide layer. Conversely, the cathodic potential condition exhibited a regrowth of the passive oxide layer, protecting the Ti6Al4V surface from further corrosion. The mid-range corrosion potential condition showed a dynamic equilibrium between corrosion and passivation processes. These electrochemical insights enhance our understanding of the mechanisms involved in fretting corrosion. The AE data proved to be promising in detecting and monitoring the onset and progression of failure mechanisms. The AE signals exhibited distinctive patterns that correlated with the severity of fretting corrosion. Notably, the hit driven data results, derived from AE signals, demonstrated the ability to differentiate between different levels of fretting conditions. This suggests that AE can serve as a valuable diagnostic tool for early detection and continuous monitoring of implant failure in THRs.
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Affiliation(s)
- Bill Keaty
- Department of Civil, Materials and Environmental Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Yani Sun
- Department of Civil, Materials and Environmental Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Ozevin Didem
- Department of Civil, Materials and Environmental Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Jacob Eapen
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, United States
| | - Mathew Mathew
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States
- Department of Biomedical Sciences, UIC College of Medicine at Rockford, Rockford, IL 61107, United States
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14
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Davey MS, Mohan K, Gavin E, Power FR, Curtin W, Kaar K, Murphy CG. Birmingham hip resurfacing: a systematic review of outcomes at minimum 10-years follow-up. Acta Orthop Belg 2023; 89:581-586. [PMID: 38205745 DOI: 10.52628/89.4.10045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Although controversy surrounding the use of metal-on-metal (MoM) arthroplasty implants continues to exist, satisfactory clinical and radiological outcomes have been reported following Birmingham Hip Resurfacing (BHR) at long-term follow-up, leading to an Orthopaedic Data Evaluation Panel (ODEP) rating of 13A. The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following BHR at a minimum of 10 years follow-up. Using the PRISMA guidelines, two independent reviewers performed a literature search using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of BHR with a minimum of 10 years' follow-up were considered for inclusion. A total of 12 studies including 7132 hips (64.8% males), with mean follow-up of 11.5 years (10-15.3), met our inclusion criteria. Of included patients, 94.3% of patient underwent BHR for osteoarthritis at a mean age was 52.0 years (48-52). At final follow-up, 96% of patients reported being satisfied with their BHR, with mean Harris Hip Scores of 93.6 and Oxford Hip Scores of 16.5. Rates of radiological femoral neck narrowing of greater than 10% and non-progressive radiological loosening were reported as 2.0% and 3.8% respectively. At final follow-up, the overall revision rate was 4.9% (334/7132), deep infection rate was 0.4%, metal allergy/insensitivity rate was 1.6%, metal reaction rate was 0.3%, rate of peri-prosthetic fracture was 0.9% and aseptic loosening rates were 1.6%. This systematic review demonstrates that BHR results in satisfactory clinical outcomes, acceptable implant survivorship, low complication rates and modest surgical revision rates in the long-term at minimum 10-year follow-up.
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15
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Jones CS, Gaillard-Campbell D, Gross TP. Long-term clinical outcomes of the Biomet M2a-38: a retrospective review of 335 total hip arthroplasty cases. J Orthop Surg Res 2023; 18:721. [PMID: 37741984 PMCID: PMC10518080 DOI: 10.1186/s13018-023-04223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/20/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND At the turn of the century, over one-third of total hip arthroplasties comprised metal-on-metal bearings. As this patient population and their implants age, it is crucial to understand associated late failure modes and expected long-term functional outcomes. We report the long-term results of a large metal-on-metal uncemented total hip arthroplasty system with unique design characteristics compared to others that have been reported with high failure rates. METHODS We retrospectively analyze our prospective clinical database to determine overall implant survivorship and functional outcomes. Further, we compare these results to the clinical outcomes reported in orthopedic registries and in other published studies with similar metal-on-metal total hip arthroplasty cohorts. RESULTS Implant survivorship at 10 years was 99.1% and continued to 97.6% survivorship at 20 years. Implant survivorship at 20 years did not vary significantly between sexes (Male: 98.3%, Female: 97.2%; log-rank p-value = 0.46). Mean whole blood cobalt levels were 2.6 µg/L in unilateral cases, 5.3 µg/L in bilateral patients, and 3.4 µg/L for the combined cohort. Average blood chromium levels were 1.4 µg/L in unilateral patients, 2.9 µg/L in bilateral patients, and 1.8 µg/L for group combined. We observed a 0.9% rate of failure due trunnion corrosion at a mean of 13.1 years postoperatively (10.6-15.6 years) but had no bearing wear failures. CONCLUSIONS Our 20-year implant survivorship of 97.6% with the M2a-38 bearing surpassed registry benchmarks for THA. This large-bearing (38 mm), full hemisphere coverage metal-on-metal system had no bearing wear failures, one failure of instability, one failure of fixation, and three trunnion failures, perhaps suggesting an optimum balance between stability of the joint and the trunnion.
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Affiliation(s)
- Caché S Jones
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
- University of South Carolina, Columbia, SC, 29208, USA
| | | | - Thomas P Gross
- Midlands Orthopaedics and Neurosurgery, 1910 Blanding Street, Columbia, SC, 29201, USA
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16
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Daher J, Desai B, Nammour M, Warren M, Chimento G. Long-term Follow-up on Revisions of a Recalled Large Head Metal-on-metal Hip Prosthesis: A Single Surgeon Series. Arthroplast Today 2023; 22:101163. [PMID: 37521732 PMCID: PMC10374868 DOI: 10.1016/j.artd.2023.101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/29/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Background In 2010, a recall was issued for a specific monoblock large head metal-on-metal (MoM) hip prosthesis due to short-term revision rates of 12%-13% (articular surface replacement, DePuy Orthopaedics, Inc., Warsaw, IN). High complication, infection, and rerevision rates for revised MoM implants have been reported. The purpose of the study is to report long-term outcomes and trend metal ion levels of this recalled MoM prosthesis from a single surgeon series. Methods Retrospective chart review was performed on all patients that underwent revision of large MoM hip replacements between 2010 and 2015. Pre- and post-revision Harris Hip Score (HHS), cup abduction angles, anteversion angles, and cup sizes were compared. Survivorship and HHS were the primary outcomes measured; serum cobalt and chromium levels were secondary outcomes. Multivariate linear regression was used to examine the correlation between prerevision serum metal ion levels and HHS. Results A total of 24 hips (21 patients) met inclusion criteria. Mean time to revision was 4.12 years ± 1.1. Mean follow-up was 10.0 years (7-11.9 years). Mean HHS increased significantly after revision from 48.5 to 89.5 (P < .001). Higher prerevision cobalt levels were correlated with lower prerevision HHS (cobalt R = 0.25; chromium R = 0.3160). There was no correlation with prerevision cobalt (P = .2671) or chromium (P = .3160) with postrevision HHS. Most recent metal ion testing revealed a significant decrease in both cobalt (P = .0084) and chromium (P = .0115). Survival rate is 100%. Conclusions Our study showed excellent survivorship and outcomes at 10 years. There were no failures for any reason including infection. This differs from previous studies and confirms excellent long-term results are possible with revision of this recalled MoM implant.
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Affiliation(s)
- Jimmy Daher
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Bhumit Desai
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
| | - Michael Nammour
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Michael Warren
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
| | - George Chimento
- Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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17
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Tang J, Zheng F, Liu X, Li Y, Guo Z, Lin X, Zhou J, Zhang Y, Yu G, Hu H, Shao W, Wu S, Li H. Cobalt induces neurodegeneration through FTO-triggered autophagy impairment by targeting TSC1 in an m 6A-YTHDF2-dependent manner. JOURNAL OF HAZARDOUS MATERIALS 2023; 453:131354. [PMID: 37054644 DOI: 10.1016/j.jhazmat.2023.131354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023]
Abstract
Cobalt is the most widely used heavy metal pollutant in medicine and industry. Excessive cobalt exposure can adversely affect human health. Neurodegenerative symptoms have been observed in cobalt-exposed populations; however, the underlying mechanisms remain largely unknown. In this study, we demonstrate that the N6-methyladenosine (m6A) demethylase fat mass and obesity-associated gene (FTO) mediates cobalt-induced neurodegeneration by impairing autophagic flux. Cobalt-induced neurodegeneration was exacerbated through FTO genetic knockdown or repression of demethylase activity, but was alleviated by FTO overexpression. Mechanistically, we showed that FTO regulates TSC1/2-mTOR signaling pathway by targeting TSC1 mRNA stability in an m6A-YTHDF2 manner, which resulted in autophagosome accumulation. Furthermore, FTO decreases lysosome-associated membrane protein-2 (LAMP2) to inhibit the integration of autophagosomes and lysosomes, leading to autophagic flux damage. In vivo experiments further identified that central nervous system (CNS)-Fto-specific knockout resulted in serious neurobehavioral and pathological damage as well as TSC1-related autophagy impairment in cobalt-exposed mice. Interestingly, FTO-regulated autophagy impairment has been confirmed in patients with hip replacement. Collectively, our results provide novel insights into m6A-modulated autophagy through FTO-YTHDF2 targeted TSC1 mRNA stability, revealing cobalt is a novel epigenetic hazard that induces neurodegeneration. These findings suggest the potential therapeutic targets for hip replacement in patients with neurodegenerative damage.
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Affiliation(s)
- Jianping Tang
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Fuli Zheng
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xu Liu
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yanjun Li
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zhenkun Guo
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xinpei Lin
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Jinfu Zhou
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yu Zhang
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Guangxia Yu
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Hong Hu
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Wenya Shao
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Siying Wu
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
| | - Huangyuan Li
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
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Wear debris in metal-on-metal bearings and modular junctions : What have we learned from the last decades? ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:206-213. [PMID: 36820850 DOI: 10.1007/s00132-023-04346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/24/2023]
Abstract
Metal-on-metal (MoM) bearing hip arthroplasty saw increasing utilization and peaked in the 1990s and early 2000s. Although the linear and volumetric wear rate for a MoM bearings was lower than its polyethylene counterpart, metal ion particles were found to be approximately 10 × smaller and 500 × higher in quantity compared to polyethylene wear debris. Research into these articulations have demonstrated their relationship to the formation of lymphocyte-mediated adverse local tissue reactions. The work-up for metal particle-associated conditions (metallosis) includes a thorough patient history and physical examination, blood laboratory studies for metal ion concentrations, and advanced imaging studies including magnetic resonance imaging (MRI). The treatment of metallosis and adverse local tissue reactions ranges from close serial observation to extensive debridement and full revision of arthroplasty components, when indicated.
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Aluminum Nanoparticles Affect Human Platelet Function In Vitro. Int J Mol Sci 2023; 24:ijms24032547. [PMID: 36768869 PMCID: PMC9916829 DOI: 10.3390/ijms24032547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Endoprostheses are prone to tribological wear and biological processes that lead to the release of particles, including aluminum nanoparticles (Al NPs). Those particles can diffuse into circulation. However, the toxic effects of NPs on platelets have not been comprehensively analyzed. The aim of our work was to investigate the impact of Al NPs on human platelet function using a novel quartz crystal microbalance with dissipation (QCM-D) methodology. Moreover, a suite of assays, including light transmission aggregometry, flow cytometry, optical microscopy and transmission electron microscopy, were utilized. All Al NPs caused a significant increase in dissipation (D) and frequency (F), indicating platelet aggregation even at the lowest tested concentration (0.5 µg/mL), except for the largest (80 nm) Al NPs. A size-dependent effect on platelet aggregation was observed for the 5-20 nm NPs and the 30-50 nm NPs, with the larger Al NPs causing smaller increases in D and F; however, this was not observed for the 20-30 nm NPs. In conclusion, our study showed that small (5-50 nm) Al NPs caused platelet aggregation, and larger (80 nm) caused a bridging-penetrating effect in entering platelets, resulting in the formation of heterologous platelet-Al NPs structures. Therefore, physicians should consider monitoring NP serum levels and platelet activation indices in patients with orthopedic implants.
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20
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Bellare A, Carvalho BL. The role of lamellar morphology on the post-irradiation oxidative degradation of ultra-high molecular weight polyethylene. Polym Degrad Stab 2022. [DOI: 10.1016/j.polymdegradstab.2022.110174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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A laser guide technique: a novel method for accurate acetabular cup alignment in total hip arthroplasty. Sci Rep 2022; 12:18247. [PMID: 36309552 PMCID: PMC9617895 DOI: 10.1038/s41598-022-21975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
For accurate cup alignment without navigation in total hip arthroplasty (THA), we developed a "laser guide technique." The major purposes of this paper are to introduce the technique and compare its accuracy with a conventional manual technique. As a clinical outcome, the dislocation rate was reviewed. Our laser guide technique, which includes preoperative postural adjustment and intraoperative angular reference, has been detailed in the manuscript. 599 hips in 523 patients who underwent primary THA with piriformis-sparing posterolateral approach in April 2010-March 2016 were reviewed. Patients were divided into three groups: conventional group (135 hips), laser guide group (80 hips), and laser + radiographic alignment guide group (384 hips). Radiographic inclination (RI) and radiographic anteversion (RA) errors were evaluated. The dislocation rate was reviewed in 540 hips in 476 patients who were followed up > 2 years postoperatively. Absolute values of the RI/RA error in the three groups were 5.3° ± 4.0°/6.5° ± 4.5°, 4.0° ± 2.8°/4.9° ± 4.4°, and 3.3° ± 2.6°/3.6° ± 2.8°, respectively, indicating substantially enhanced accuracy with laser and radiographic alignment guide. The dislocation rates were 2.5% (3/119) and 0.2% (1/421) in the conventional and laser groups, respectively. Our novel laser guide technique considerably enhanced cup alignment accuracy, suggesting its potential applicability for THA in the lateral decubitus position.
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22
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Meier SK, Pollock BD, Kurtz SM, Lau E. State and Government Administrative Databases: Medicare, National Inpatient Sample (NIS), and State Inpatient Databases (SID) Programs. J Bone Joint Surg Am 2022; 104:4-8. [PMID: 36260036 DOI: 10.2106/jbjs.22.00620] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The availability of large state and federally run administrative health-care databases provides potentially comprehensive population-wide information that can dramatically impact both medical and health-policy decision-making. Specific opportunities and important limitations exist with all administrative databases based on what information is collected and how reliably specific data elements are reported. Access to patient identifiable-level information can be critical for certain long-term outcome studies but can be difficult (although not impossible) due to patient privacy protections, while more easily available de-identified information can provide important insights that may be more than sufficient for some short-term operative or in-hospital outcome questions. The first section of this paper by Sarah K. Meier and Benjamin D. Pollock discusses Medicare and the different data files available to health-care researchers. They describe what is and is not generally available from even the most granular Medicare Standard Analytic Files, and provide an analysis of the strengths and weaknesses of Medicare administrative data as well as the resulting best and inappropriate uses of these data. In the second section, the Nationwide Inpatient Sample and complementary State Inpatient Database programs are reviewed by Steven M. Kurtz and Edmund Lau, with insights into the origins of these programs, the data elements that are recorded relating to the operative procedure and hospital stay, and examples of the types of studies that optimally utilize these data sources. They also detail the limitations of these databases and identify studies that they are not well-suited for, especially those involving linkage or longitudinal studies over time. Both sections provide useful guidance on the best uses and pitfalls related to these important large representative national administrative data sources.
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Affiliation(s)
- Sarah K Meier
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,Division of External Relations, Mayo Clinic, Rochester, Minnesota
| | - Benjamin D Pollock
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
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Semaan DJ, Rutledge-Jukes H, Berend KR, Lombardi AV, Adams JB, Crawford DA. Survivorship of a Metal-on-Metal Total Hip Implant With Modular Titanium Adapter. J Arthroplasty 2022; 37:S560-S565. [PMID: 35219576 DOI: 10.1016/j.arth.2022.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of metal-on-metal (MoM) articulations in total hip arthroplasty (THA) has sharply declined due to high failure rates from metal-related complications. Although certain MoM designs have demonstrated only 46% survival, not all MoM designs have performed the same. The purpose of this study is to evaluate mid-term to long-term survival of a specific MoM implant with a modular titanium taper adapter. METHODS A retrospective review was performed on all patients who underwent primary THA at our center with the M2a-Magnum system (Zimmer Biomet, Warsaw, IN). Of 829 patients (956 hips) identified, 754 patients (869 hips) met inclusion criteria of signed research consent, minimum 2-year follow-up, and/or any revision surgery. RESULTS Mean follow-up was 11.0 years (range 2-16; ±3.5). Mean cup angle of inclination was 42.8° (range 24°-70°, ±6.3°), with 88.0% reconstructed within the 40° ± 10° safe zone. There were 64 revisions (7.36%): 7 (0.81%) septic and 57 (6.56%) aseptic. Of those, 32 (3.68%) were adverse reactions to metal debris. Kaplan-Meier survival free of revision for all causes was 88.6% at 16 years (95% confidence interval 86.8-90.4). Univariate analysis of risk factors for all-cause, aseptic, and adverse reaction to metal debris revision found no relationship with female gender, age ≥65 years, body mass index >30 kg/m2, higher activity level, or inclination angle outlier. CONCLUSION The results of this study demonstrate a more favorable mid-term to long-term survivorship with this specific MoM implant compared to other designs. Although our institution no longer performs MoM THA, further investigation into differences in MoM implant designs is warranted.
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Affiliation(s)
- Derek J Semaan
- Joint Implant Surgeons Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | | | - Keith R Berend
- Joint Implant Surgeons Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, Ohio
| | | | - David A Crawford
- Joint Implant Surgeons Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
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Bitar C, Moberg I, Krupic F, Wretenberg P, Otten V, Crnalic S. 11-Year outcomes in patients with metal-on-metal ASR hip arthroplasty. J Orthop 2022; 32:98-103. [PMID: 35663448 PMCID: PMC9160402 DOI: 10.1016/j.jor.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background We analysed the long-term revision rate, clinical outcomes and metal ion concentrations in blood over time in patients who had undergone metal-on-metal Articular Surface Replacement (ASR) hip arthroplasty. Methods A total of 38 patients (43 hips) were included: 24 patients (28 hips) underwent large-head total hip arthroplasty (XL THA), and 14 patients (15 hips) underwent hip resurfacing arthroplasty (HRA). The median follow-up time was 11 (range 7-12) years. Results None of 15 HRA implants were revised. Nine of 28 XL THA implants (32%) in 8 patients were revised. The Co ion levels significantly increased in the XL THA group (p=0.009) over a median time period of 84 (25-97) months. Conclusion The levels of Co ions in blood were higher in the patients who had undergone XL THA and increased significantly over time.
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Affiliation(s)
- Christian Bitar
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Ivan Moberg
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Wretenberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden
| | - Volker Otten
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, Umeå, Sweden
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Langton DJ, Bhalekar RM, Joyce TJ, Rushton SP, Wainwright BJ, Nargol ME, Shyam N, Lie BA, Pabbruwe MB, Stewart AJ, Waller S, Natu S, Ren R, Hornick R, Darlay R, Su EP, Nargol AVF. The influence of HLA genotype on the development of metal hypersensitivity following joint replacement. COMMUNICATIONS MEDICINE 2022; 2:73. [PMID: 35761834 PMCID: PMC9232575 DOI: 10.1038/s43856-022-00137-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/07/2022] [Indexed: 12/27/2022] Open
Abstract
Background Over five million joint replacements are performed across the world each year. Cobalt chrome (CoCr) components are used in most of these procedures. Some patients develop delayed-type hypersensitivity (DTH) responses to CoCr implants, resulting in tissue damage and revision surgery. DTH is unpredictable and genetic links have yet to be definitively established. Methods At a single site, we carried out an initial investigation to identify HLA alleles associated with development of DTH following metal-on-metal hip arthroplasty. We then recruited patients from other centres to train and validate an algorithm incorporating patient age, gender, HLA genotype, and blood metal concentrations to predict the development of DTH. Accuracy of the modelling was assessed using performance metrics including time-dependent receiver operator curves. Results Using next-generation sequencing, here we determine the HLA genotypes of 606 patients. 176 of these patients had experienced failure of their prostheses; the remaining 430 remain asymptomatic at a mean follow up of twelve years. We demonstrate that the development of DTH is associated with patient age, gender, the magnitude of metal exposure, and the presence of certain HLA class II alleles. We show that the predictive algorithm developed from this investigation performs to an accuracy suitable for clinical use, with weighted mean survival probability errors of 1.8% and 3.1% for pre-operative and post-operative models respectively. Conclusions The development of DTH following joint replacement appears to be determined by the interaction between implant wear and a patient's genotype. The algorithm described in this paper may improve implant selection and help direct patient surveillance following surgery. Further consideration should be given towards understanding patient-specific responses to different biomaterials.
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Affiliation(s)
- David J. Langton
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Rohan M. Bhalekar
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | | | | | | | - Matthew E. Nargol
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Nish Shyam
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, England
| | - Benedicte A. Lie
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Oslo, Norway
| | | | - Alan J. Stewart
- School of Medicine, University of St Andrews, St Andrews, Scotland
| | - Susan Waller
- University Hospital of North Tees, Stockton, England
| | - Shonali Natu
- University Hospital of North Tees, Stockton, England
| | - Renee Ren
- Hospital for Special Surgery, New York, USA
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Díaz-Dilernia F, Sanchez-Mele H, Zanotti G, Comba F, Piccaluga F, Buttaro M. Fracture of a triple-polished tapered cemented femoral stem at the Morse taper after metal-on-metal primary total hip arthroplasty. Ann R Coll Surg Engl 2022; 104:e128-e132. [PMID: 34939858 PMCID: PMC9773908 DOI: 10.1308/rcsann.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Total hip arthroplasty, one of the most successful orthopaedic procedures, is influenced by several variables. Corrosion at the modular junction is known as trunnionosis. Despite being reported infrequently, corrosion between the femoral head and the Morse taper can result in severe complications. Fracture of the femoral component in primary metal-on-metal (MoM) total hip arthroplasty at the Morse taper is an extremely rare event and can be associated with several risk factors. We report a case of corrosion at the Morse taper in a hybrid primary MoM total hip arthroplasty, resulting in Morse taper fracture with consequent femoral head entrapment inside the acetabular component. We hypothesise that some risk factors, such as age over 60years, active male patients, body mass index above 30kg/m2, large femoral heads, high-offset stems, 9/10 Morse taper and MoM-bearing surfaces, are associated with this mode of failure.
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Affiliation(s)
- F Díaz-Dilernia
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - H Sanchez-Mele
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
| | - M Buttaro
- Institute of Orthopedics ‘Carlos E. Ottolenghi’, Italian Hospital of Buenos Aires, Argentina
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Kelly GA, Hill JC, O'Brien S, McChesney J, Dennison J, Stevenson M, Beverland DE. Ten-year outcomes following a cohort of ASR XL total hip arthroplasties. Hip Int 2021; 31:759-765. [PMID: 32233664 DOI: 10.1177/1120700020913863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To determine the outcome at 10 years of a cohort of ASR XL total hip arthroplasties (THAs) and reasons for revision. METHODS Between November 2005 and May 2007, 122 ASR XL THAs were implanted. All patients had a routine review at 6 weeks and 1 year, followed by a review in 2009 because of clinical concern and thereafter annual review up to 10 years with MRI. Review also included functional scores, radiographs, pain scores and blood metal ions. RESULTS 67 (54.9%) ASR XLs had been revised by 11.1 years. Reasons for revision included pain (89.6%), high levels of cobalt and chromium ions (50.7%) and radiographic or MRI changes (80.6%). All 3 factors were present in 23 (34.3%). Pain at 1 year did not predict revision, but pain at the 2009 review did. At 10 years the revised patients had an average Oxford Hip Score (OHS) of 25.38 (12-42) and the non-revised 23.61 (2-21), the difference was not significant (p = 0.48). 3 patients (4.5%) have had a further revision; 2 for a previously unrevised stem and the other for instability. CONCLUSIONS Our arthroplasty care practitioner service allowed us to identify increased pain and stop using the ASR XL over 3 years before the implant was recalled. The revised patients had similar functional outcome to those unrevised. Poorly performing implants need to be identified earlier.
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Affiliation(s)
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
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Zheng F, Li Y, Zhang F, Sun Y, Zheng C, Luo Z, Wang YL, Aschner M, Zheng H, Lin L, Cai P, Shao W, Guo Z, Zheng M, Zhou XZ, Lu KP, Wu S, Li H. Cobalt induces neurodegenerative damages through Pin1 inactivation in mice and human neuroglioma cells. JOURNAL OF HAZARDOUS MATERIALS 2021; 419:126378. [PMID: 34175703 DOI: 10.1016/j.jhazmat.2021.126378] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/29/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Cobalt is a hazardous material that has harmful effects on neurotoxicity. Excessive exposure to cobalt or inactivation of the unique proline isomerase Pin1 contributes to age-dependent neurodegeneration. However, nothing is known about the role of Pin1 in cobalt-induced neurodegeneration. Here we find that out of several hazardous materials, only cobalt dose-dependently decreased Pin1 expression and alterations in its substrates, including cis and trans phosphorylated Tau in human neuronal cells, concomitant with neurotoxicity. Cobalt-induced neurotoxicity was aggravated by Pin1 genetic or chemical inhibition, but rescued by Pin1 upregulation. Furthermore, less than 4 μg/l of blood cobalt induced dose- and age-dependent Pin1 downregulation in murine brains, ensuing neurodegenerative changes. These defects were corroborated by changes in Pin1 substrates, including cis and trans phosphorylated Tau, amyloid precursor protein, β amyloid and GSK3β. Moreover, blood Pin1 was downregulated in human hip replacement patients with median blood cobalt level of 2.514 μg/l, which is significantly less than the safety threshold of 10 μg/l, suggesting an early role Pin1 played in neurodegenerative damages. Thus, Pin1 inactivation by cobalt contributes to age-dependent neurodegeneration, revealing that cobalt is a hazardous material triggering AD-like neurodegenerative damages.
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Affiliation(s)
- Fuli Zheng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yuqing Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Fengshun Zhang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yi Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Chunyan Zheng
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zhousong Luo
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yuan-Liang Wang
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | - Hong Zheng
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China
| | - Liqiong Lin
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China
| | - Ping Cai
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Health Inspection and Quarantine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Wenya Shao
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Zhenkun Guo
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Min Zheng
- Institute for Translational Medicine, Fujian Medical University, Fuzhou 350122, China
| | - Xiao Zhen Zhou
- Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Kun Ping Lu
- Division of Translational Therapeutics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Siying Wu
- Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China; Fujian Provincial Key Laboratory of Environmental Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350122, China; The Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou 350122, China.
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Comparison of patient reported outcome measures after single versus two-stage revision for chronic infection of total hip arthroplasty: a retrospective propensity score matched cohort study. Arch Orthop Trauma Surg 2021; 141:1789-1796. [PMID: 33783636 DOI: 10.1007/s00402-021-03810-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Two-stage revision is the current gold standard treatment for infected total hip arthroplasties (THA) with good clinical outcomes. Single-stage revision THA offers the advantage of only a single surgical intervention, potentially leading to improved functional outcomes. This study aimed to compare the differences in patient-reported outcome measures (PROMs) and complications between single and two-stage revision THA for chronic periprosthetic joint infection (PJI). METHODS A total of 159 consecutive revision THA patients for chronic PJI with complete pre-and post-operative patient-reported outcome measures (PROM) was investigated. A total of 46 patients with single-stage revision THA was matched to 92 patients following two-stage revision THA using propensity score matching, yielding a total of 136 propensity score-matched patients for analysis. RESULTS Single and two-stage revision THA improved PROM scores post-operatively, with significantly higher PROMs for single-stage revision THA (HOOS-PS: 50.7 vs 46.4, p = 0.04; Physical SF 10A: 42.1 vs 36.6, p < 0.001; PROMIS SF Physical: 41.4 vs 37.4, p < 0.001; PROMIS SF Mental: 52.8 vs 47.6, p < 0.001). There was no significant difference between both cohorts for reinfection rates (p = 0.81) and 90-day mortality rates (p = 1.0). CONCLUSION This study found a demonstrable functional benefit of single-stage revision compared to two-stage revision for THA with chronic periprosthetic joint infection, suggesting that single-stage revision THA may provide an effective alternative to two-stage revision in selected patients with chronic PJI. LEVEL OF EVIDENCE Level III, case-control retrospective analysis.
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Hodges NA, Sussman EM, Stegemann JP. Aseptic and septic prosthetic joint loosening: Impact of biomaterial wear on immune cell function, inflammation, and infection. Biomaterials 2021; 278:121127. [PMID: 34564034 DOI: 10.1016/j.biomaterials.2021.121127] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
The success of total joint replacements has led to consistent growth in the use of arthroplasty in progressively younger patients. However, more than 10 percent of patients require revision surgeries due to implant failure caused by osteolytic loosening. These failures are classified as either aseptic or septic and are associated with the presence of particulate wear debris generated by mechanical action between implant components. Aseptic loosening results from chronic inflammation caused by activation of resident immune cells in contact with implant wear debris. In contrast, septic loosening is defined by the presence of chronic infection at the implant site. However, recent findings suggest that subclinical biofilms may be overlooked when evaluating the cause of implant failure, leading to a misdiagnosis of aseptic loosening. Many of the inflammatory pathways contributing to periprosthetic joint infections are also involved in bone remodeling and resorption. In particular, wear debris is increasingly implicated in the inhibition of the innate and adaptive immune response to resolve an infection or prevent hematogenous spread. This review examines the interconnectivity of wear particle- and infection-associated mechanisms of implant loosening, as well as biomaterials-based strategies to combat infection-related osteolysis.
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Affiliation(s)
- Nicholas A Hodges
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, MI, 48109, USA; Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, Silver Spring, MD, 20993, USA.
| | - Eric M Sussman
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, Silver Spring, MD, 20993, USA.
| | - Jan P Stegemann
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, MI, 48109, USA.
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Hersnaes PN, Gromov K, Otte KS, Gebuhr PH, Troelsen A. Harris Hip Score and SF-36 following metal-on-metal total hip arthroplasty and hip resurfacing - a randomized controlled trial with 5-years follow up including 75 patients. BMC Musculoskelet Disord 2021; 22:781. [PMID: 34511090 PMCID: PMC8436430 DOI: 10.1186/s12891-021-04671-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background The metal-on-metal large-diameter-head (MoM-LDH) hip replacements increased in popularity during the start of the twenty-first century. Subsequently reports raised concerns regarding adverse reactions due to elevated chromium (Cr) and cobalt (Co) concentrations as well as high rates of other complications and revisions. The purpose was to compare Harris Hip Score and SF-36 at 5-years follow up following MoM-LDH total hip arthroplasty (MoM-LDH-THA) or MoM hip resurfacing (MoM-HR). Methods The study was conducted between November 2006 to January 2012 in a tertiary health care center in Denmark. Patients with primary or secondary osteoarthritis were randomly assigned to receive a Magnum (MoM-LDH-THA) or a Recap (MoM-HR) prosthesis. Randomization was computer generated and allocation was concealed in an opaque envelope. Neither patients nor care provider were blinded. Primary outcome was Harris Hip Score at 5-years follow up. Results Seventy-five were included and allocated to the MoM-LDH-THA (n = 39) and MoM-HR (n = 36) group. The study was prematurely stopped due to numerous reports of adverse events in patients with MoM hip replacements. Thirty-three in the MoM-LDH-THA and 25 in the MoM-HR group were available for primary outcome analysis. Median Harris Hip Score was 100 (IQR: 98–100) for MoM-LDH-THA and 100 (IQR: 93–100) for MoM-HR (p = 0.486). SF-36 score was high in both groups with no significant difference between groups. Conclusion Harris Hip Score and SF-36 score was excellent in both groups with no significant difference at 5-years follow up. Our findings suggest that there is no clinical important difference between the two prostheses implanted 5 years after implantation. Trial registration ClinicalTrials.gov, NCT04585022, Registered 23 September 2020 – Retrospectively registered. This study was not prospectively registered in a clinical trial database since it was not an entirely implemented standard procedure in the international orthopedic society when the study was planned.
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Affiliation(s)
- Peter Nyby Hersnaes
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristian Stahl Otte
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Peter Henrik Gebuhr
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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McCarthy SM, Hall DJ, Mathew MT, Jacobs JJ, Lundberg HJ, Pourzal R. Are Damage Modes Related to Microstructure and Material Loss in Severely Damaged CoCrMo Femoral Heads? Clin Orthop Relat Res 2021; 479:2083-2096. [PMID: 34019490 PMCID: PMC8373544 DOI: 10.1097/corr.0000000000001819] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fretting and corrosion in metal-on-polyethylene total hip arthoplasty (THA) modular junctions can cause adverse tissue reactions that are responsible for 2% to 5% of revision surgeries. Damage within cobalt-chromium-molybdenum (CoCrMo) alloy femoral heads can progress chemically and mechanically, leading to damage modes such as column damage, imprinting, and uniform fretting damage. At present, it is unclear which of these damage modes are most detrimental and how they may be linked to implant alloy metallurgy. The alloy microstructure exhibits microstructural features such as grain boundaries, hard phases, and segregation bands, which may enable different damage modes, higher material loss, and the potential risk of adverse local tissue reactions. QUESTIONS/PURPOSES In this study, we asked: (1) How prevalent is chemically dominated column damage compared with mechanically dominated damage modes in severely damaged metal-on-polyethylene THA femoral heads made from wrought CoCrMo alloy? (2) Is material loss greater in femoral heads that underwent column damage? (3) Do material loss and the presence of column damage depend on alloy microstructure as characterized by grain size, hard phase content, and/or banding? METHODS Surgically retrieved wrought CoCrMo modular femoral heads removed between June 2004 and June 2019 were scored using a modified version of the Goldberg visually based scoring system. Of the total 1002 heads retrieved over this period, 19% (190 of 1002) were identified as severely damaged, exhibiting large areas of fretting scars, black debris, pits, and/or etch marks. Of these, 43% (81 of 190) were excluded for metal-on-metal articulations, alternate designs (such as bipolar, dual-mobility, hemiarthroplasty, metal adaptor sleeves), or previous sectioning of the implant for past studies. One sample was excluded retroactively as metallurgical analysis revealed that it was made of cast alloy, yielding a total of 108 for further analysis. Information on patient age (57 ± 11 years) and sex (56% [61 of 108] were males), reason for removal, implant time in situ (99 ± 78 months), implant manufacturer, head size, and the CoCrMo or titanium-based stem alloy pairing were collected. Damage modes and volumetric material loss within the head tapers were identified using an optical coordinate measuring machine. Samples were categorized by damage mode groups by column damage, imprinting, a combination of column damage and imprinting, or uniform fretting. Metallurgical samples were processed to identify microstructural characteristics of grain size, hard phase content, and banding. Nonparametric Mann-Whitney U and Kruskal-Wallis statistical tests were used to examine volumetric material loss compared with damage mode and microstructural features, and linear regression was performed to correlate patient- and manufacturer-specific factors with volumetric material loss. RESULTS Chemically driven column damage was seen in 48% (52 of 108) of femoral heads, with 34% (37 of 108) exhibiting a combination of column damage and imprinting, 12% (13 of 108) of heads displaying column damage and uniform fretting, and 2% (2 of 108) exhibiting such widespread column damage that potentially underlying mechanical damage modes could not be verified. Implants with column damage showed greater material loss than those with mechanically driven damage alone, with median (range) values of 1.2 mm3 (0.2 to 11.7) versus 0.6 mm3 (0 to 20.7; p = 0.03). Median (range) volume loss across all femoral heads was 0.9 mm3 (0 to 20.7). Time in situ, contact area, patient age, sex, head size, manufacturer, and stem alloy type were not associated with volumetric material loss. Banding of the alloy microstructure, with a median (range) material loss of 1.1 mm3 (0 to 20.7), was associated with five times higher material loss compared with those with a homogeneous microstructure, which had a volume loss of 0.2 mm3 (0 to 4.1; p = 0.02). Hard phase content and grain size showed no correlation with material loss. CONCLUSION Chemically dominated column damage was a clear indicator of greater volume loss in this study sample of 108 severely damaged heads. Volumetric material loss strongly depended on banding (microstructural segregations) within the alloy. Banding of the wrought CoCrMo microstructure should be avoided during the manufacturing process to reduce volumetric material loss and the release of corrosion products to the periprosthetic tissue. CLINICAL RELEVANCE Approximately 30% of THAs rely on wrought CoCrMo femoral heads. Most femoral heads in this study exhibited a banded microstructure that was associated with larger material loss and the occurrence of chemically dominated column damage. This study suggests that elimination of banding from the alloy could substantially reduce the release of implant debris in vivo, which could potentially also reduce the risk of adverse local tissue reactions to implant debris.
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Affiliation(s)
| | - Deborah J. Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hannah J. Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Bedard NA, Carender CN, DeMik DE, Browne JA, Schwarzkopf R, Callaghan JJ. The Impact of Transitioning From International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision on Reported Complication Rates Following Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:1617-1620. [PMID: 33388203 DOI: 10.1016/j.arth.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2015, the healthcare system transitioned from International Classification of Diseases, Ninth Revision (ICD-9) coding to the Tenth Revision (ICD-10). We sought to determine the effect of this change on the reported incidence of complications following total knee arthroplasty (TKA). METHODS The Humana administrative claims database was queried from 2 years prior to October 1, 2015 (ICD-9 cohort) and for 1 year after this date (ICD-10 cohort) to identify all TKA procedures. Complications occurring within 6 months of surgery were captured using the respective coding systems. Incidence of each complication was compared between cohorts using risk ratios (RR) and 95% confidence intervals. RESULTS There were 19,009 TKAs in the ICD-10 cohort and 38,172 TKAs in the ICD-9 cohort. The incidence of each complication analyzed was significantly higher in the ICD-9 cohort relative to the ICD-10 cohort. Periprosthetic joint infection occurred in 1.9% vs 1.3% (RR 1.5, 1.3-1.9), loosening in 0.3% vs 0.1% (RR 2.7, 1.8-4.9), periprosthetic fracture in 0.3% vs 0.1% (RR 3.0, 1.6-4.5), and other mechanical complications in 0.7% vs 0.4% (RR 2.0, 1.5-2.5) (P < .05 for all). CONCLUSION The transition from ICD-9 to ICD-10 coding has altered the reported incidence of complications following TKA. These results are likely due to the added complexity of ICD-10 which is joint and laterality specific. It is important to understand the differences between coding systems as this data is used for quality initiatives, risk adjustment models, and clinical research. Thoughtful methodology will be necessary when ICD-9 and ICD-10 data are being analyzed simultaneously.
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Affiliation(s)
- Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Christopher N Carender
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - David E DeMik
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
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Sommer YL, Ward CD, Georgi JC, Cheng PY, Jones RL. Importance of Preanalytical Factors in Measuring Cr and Co Levels in Human Whole Blood: Contamination Control, Proper Sample Collection and Long-Term Storage Stability. J Anal Toxicol 2021; 45:297-307. [PMID: 32514534 DOI: 10.1093/jat/bkaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
A number of errors with potentially significant consequences may be introduced at various points in the analytical process, which result in skewed, erroneous analytical results. Precautionary procedures such as contamination control, following established sample collection protocols, and having a complete understanding of the long-term stability of the elements of interest can minimize or eliminate these errors. Contamination control is critical in the quantification of Cr and Co in human whole blood. Cr and Co levels in most biological samples are low, but these elements occur naturally in the environment and are often found in commercial and consumer products, which increases the risk of contamination. In this paper, we demonstrated that lot screening process in which we pre-screen a sub-set of manufactured lots used in collecting, analyzing and storing blood samples is a critical step in controlling Cr and Co contamination. Stainless steel needles are often utilized in blood collection but are considered as a potential source of introducing metal contamination to the patient sample. We conducted two studies to determine if there is a possibility of Cr or Co leaching into the human whole blood from the needles during blood collection. We analyzed blood collected from 100 donors and blood collected in vitro in the laboratory from designated vessel containing spiked blood with higher levels of Cr and Co. Two blood tubes were consecutively collected through one needle. In both studies, Cr and Co concentration levels in the two consecutively collected tubes were compared. Based on the results from donor and in vitro blood collection studies, we concluded that there was no Cr and Co leaching from the limited sets of stainless steel needles used in these studies. Furthermore, we demonstrated that Cr and Co human whole blood samples are stable for 1 year stored at temperatures of -70, -20 and 4°C and 6 months at room temperature.
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Affiliation(s)
- Yuliya L Sommer
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Inorganic and Radiation Analytical Toxicology Branch, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Cynthia D Ward
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Inorganic and Radiation Analytical Toxicology Branch, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Joaudimir Castro Georgi
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Inorganic and Radiation Analytical Toxicology Branch, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Po-Yung Cheng
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Inorganic and Radiation Analytical Toxicology Branch, 4770 Buford Highway NE, Atlanta, GA 30341, USA
| | - Robert L Jones
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Inorganic and Radiation Analytical Toxicology Branch, 4770 Buford Highway NE, Atlanta, GA 30341, USA
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Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty Reduces the Risk for Revision for Periprosthetic Joint Infection Compared to Ceramic-on-Polyethylene: A Matched Analysis of 118,753 Cementless THA Based on the German Arthroplasty Registry. J Clin Med 2021; 10:jcm10061193. [PMID: 33809212 PMCID: PMC8002089 DOI: 10.3390/jcm10061193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most common complications in total hip arthroplasty (THA). The influence of bearing material on the risk of PJI remains unclear to date. This registry-based matched study investigates the role of bearing partners in primary cementless THA. Primary cementless THAs recorded in the German Arthroplasty Registry since 2012 with either a ceramic-on-ceramic (CoC) or ceramic-on-polyethylene (CoP) bearings were included in the analysis. Using propensity score matching (PSM) for age, sex, obesity, diabetes mellitus, Elixhauser comorbidity index, year of surgery and head size, we compared the risk for revision for PJI for CoC and CoP. Within the 115,538 THAs (87.1% CoP; 12.9% CoC), 977 revisions were performed due to PJI. There was a significantly higher risk for revision for PJI for CoP compared with CoC over the whole study period (p < 0.01) after 2:1 matching (CoP:CoC) with a hazard ratio of 1.41 (95% confidence interval (CI), 1.09 to 1.80) After 3 years, the risk for revision for PJI was 0.7% (CI 0.5–0.9%) for CoC and 0.9% (CI 0.8–1.1%) for CoP. The risk for revision for all other reasons except PJI did not significantly differ between the two groups over the whole study period (p = 0.4). Cementless THAs with CoC bearings were less likely to be revised because of infection in mid-term follow-up. In the future, registry-embedded studies focusing on long-term follow-up, including clinical data, as well as basic science studies, may give a deeper insight into the influence of the bearing partners.
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Royhman D, Pourzal R, Hall D, Lundberg HJ, Wimmer MA, Jacobs J, Hallab NJ, Mathew MT. Fretting-corrosion in hip taper modular junctions: The influence of topography and pH levels - An in-vitro study. J Mech Behav Biomed Mater 2021; 118:104443. [PMID: 33752094 DOI: 10.1016/j.jmbbm.2021.104443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/03/2020] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
Contemporary hip implants feature a modular design. Increased reported failure rates associated with the utilization of modular junctions have raised many clinical concerns. Typically, these modular interfaces contain circumferential machining marks (threads or microgrooves), but the effect of the machining marks on the fretting-corrosion behavior of total hip implant materials is unknown. This study reports the effects of microgrooves on the fretting-corrosion behavior of hip implant materials. The flat portions of two cylindrical, polished, CrCrMo alloy pins were loaded horizontally against one rectangular Ti alloy rod. Two surface preparation groups were used for the Ti6Al4V rod (polished and machined). The polished group was prepared using the same methods as the CoCrMo pins. The machined samples were prepared by creating parallel lines on the rod surfaces to represent microgrooves present on the stem tapers of head-neck modular junctions. Newborn calf serum (30 g/L protein content; 37 °C) at pH of levels of 7.6 and 3.0 were used to simulate the normal joint fluid and a lowered pH within a crevice, respectively. The samples were tested in a fretting corrosion apparatus under a 200N normal force and a 1Hz sinusoidal fretting motion with a displacement amplitude of 25 μm. All electrochemical measurements were performed with a potentiostat in a three-electrode configuration. The results show significant differences between machined samples and polished samples in both electrochemical and mechanical responses. In all cases, the magnitude of the drop in potential was greater in the machined group compared to the polished group. The machined group showed a lower total dissipated friction energy for the entire test compared to the polished group. Additionally, the potentiostatic test measurements revealed a higher evolved charge in the machined group compared to the polished group at both pH conditions (pH 7.6 and 3.0). The machined surfaces lowered the overall dissipated friction energy at pH 7.6 compared to pH 3.0, but also compromised electrochemical performance in the tested conditions. Therefore, the role of synergistic interaction of wear and corrosion with surface topographical changes is evident from the outcome of the study. Despite the shift towards higher electrochemical destabilization in the machined group, both polished and machined groups still exhibited a mechanically dominated degradation.
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Affiliation(s)
- Dmitry Royhman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Hannah J Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadim J Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mathew T Mathew
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA.
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Kavolus JJ, Lazarides AL, Moore C, Seyler TM, Wellman SS, Attarian DE, Bolognesi MP, Alman BA. The Calpain Gene is Correlated With Metal-on-Metal Hip Replacement Failures. J Arthroplasty 2021; 36:236-241.e3. [PMID: 32811707 DOI: 10.1016/j.arth.2020.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal-on-metal (MOM) total hip arthroplasty is associated with unacceptable failure rates secondary to metal ion reactions. Efforts to identify which patients will go on to failure have been limited; recently, there has been a suggestion for a potential genetic basis for the increased risk of revision in MOM hip replacements (MOMHRs). The purpose of this study is to determine whether certain immunologic genotypes are predictive of the need for revision in patients with MOM total hip implants. METHODS This is a case-control study of all patients undergoing primary MOMHR between September 2002 and January 2012 with a minimum of 5-year follow-up. Our investigational "case" cohort was comprised of patients who underwent revision for MOMHR for a reason other than infection. A single-nucleotide polymorphism (SNP) array analysis was performed to identify a potential genetic basis for failure. RESULTS Thirty-two patients (15 case and 17 control) were included in our analysis. All patients in the revision group had a chief complain of pain; revision patients were more likely to have a posterior approach (P = .01) and larger head size (P = .04) than nonrevision patients. No patient or implant characteristics were independently associated with revision in a multivariate analysis. Patients with SNP kgp9316441 were identified as having an increased odds of revision for MOM failure (P < .001). CONCLUSION This study identified an SNP, kgp9316441, encoding proteins associated with inflammation and macrophage activation. This SNP was associated with significantly increased odds of revision for MOMHR. Future studies are warranted to validate this gene target both in vitro and in vivo. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Joseph J Kavolus
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | | | - Christina Moore
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - David E Attarian
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Benjamin A Alman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Pogliacomi F, Schiavi P, Calderazzi F, Leigheb M, Domenichini M, Pedrazzini A, Ceccarelli F, Vaienti E. Is there a relation between clinical scores and serum ion levels after MoM-THA? One year results in 383 implants. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020014. [PMID: 33559629 PMCID: PMC7944688 DOI: 10.23750/abm.v91i14-s.10955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Adverse reaction to metal debris is the major cause of the high revision rates of metal on metal hip implants with femoral head size ≥ 36mm. Health authorities recommend regular surveillance even for asymptomatic individuals. The main investigations used are Co+ and Cr+ serum levels, x-rays and, eventually, ultrasound and MARS-MRI. Clinic is also assessed. The aim of this study is to identify if there is a relation between ion levels and the clinical scores in order to evaluate the outcome and plan the correct management after this type of implant. METHODS 383 subjects were included and divided in 3 groups (serum ion levels >, < and >60 µg/L). Co+, Cr+, HHS and OHS results of 1 2017 were analysed in order to show a correlation between ion levels and clinical scores . RESULTS Clinical scores were similar in group 1 and 2. Differences were observed comparing the group 1 and 2 with group 3 for both variables. DISCUSSION AND CONCLUSIONS Surveillance algorithms have been introduced by health authorities. Nevertheless, the indication to revision surgery is not simple especially in those cases in which a discrepancy between clinic and investigations is present. In this study clinical scores seem to be less important than ion levels in the evaluation of outcomes and in order to plan the correct management in the majority of cases. Larger studies are needed to highlight the real importance of clinical scores in the decision making after these type of implants.
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Affiliation(s)
- Francesco Pogliacomi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Paolo Schiavi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Massimiliano Leigheb
- Department of Health Sciences, University of Eastern Piedmont (UPO) Orthopaedics and Traumatology Unit, "Maggiore della Carità" Hospital, Novara, Italy.
| | - Marco Domenichini
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | | | - Francesco Ceccarelli
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
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Measurement of Serum Anti-staphylococcal Antibodies Increases Positive Predictive Value of Preoperative Aspiration for Hip Prosthetic Joint Infection. Clin Orthop Relat Res 2020; 478:2786-2797. [PMID: 32667753 PMCID: PMC7899396 DOI: 10.1097/corr.0000000000001392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative synovial fluid culture is pivotal in the early diagnosis of prosthetic joint infection (PJI) but may yield false-positive and false-negative results. We evaluated the predictive value of synovial fluid culture results combined with the measurement of serum anti-staphylococcal antibodies (SASA). QUESTIONS/PURPOSES (1) For hip and knee PJI, does combining positive SASA results with preoperative synovial culture results improve the positive predictive value (PPV) of preoperative synovial fluid culture alone? (2) Does combining preoperative synovial fluid culture results with a positive cell count and differential result increase the PPV of preoperative synovial fluid culture alone? (3) What proportion of isolated organisms exhibit concordance in antibiotic susceptibility: preoperative aspiration versus intraoperative isolates? METHODS A prospective study was conducted at two French reference centers that manage bone and joint infections and included 481 adult patients who had a revision or resection arthroplasty between June 25, 2012 and June 23, 2014. Exclusion criteria including no serum sample available for immunoassay, the lack of microbiological documentation, and the absence of preoperative aspiration reduced the patient number to 353. Seven patients with an undetermined SASA result were excluded from the analysis. We also excluded patients with PJI involving more than one Staphylococcus species (polystaphylococcal infection) and those in whom more than one Staphylococcus species was recovered from the preoperative synovial fluid culture (polystaphylococcal synovial fluid culture). In total, 340 patients were included in the analysis (no infection, 67% [226 of 340]; staphylococcal infection, 21% [71 of 340]; other infection, 13% [43 of 340]). The preoperative synovial fluid analysis included a cell count and differential and bacterial culture. SASAs were measured using a multiplex immunoassay. The diagnosis of PJI was determined using the Infectious Diseases Society of America (IDSA) criteria [] and intraoperative tissue culture at the time of revision surgery was used as the gold standard (at least one positive intraoperative sample for a "virulent" organism (such as S. aureus) or two positive samples for a "non-virulent" (for example S. epidermidis). RESULTS SASA increased the PPV compared with synovial fluid culture alone (92% [95% CI 82 to 97] versus 79% [95% CI 68 to 87]; p = 0.04); when stratified by site, an increase in PPV was seen in hip infections (100% [95% CI 89 to 100] versus 77% [95% CI 63 to 88]; p = 0.01) but not in knee infections (84% [95% CI 66 to 95] versus 80% [95% CI 64 to 91]; p = 0.75). A positive cell count and differential result increased the PPV of staphylococcal synovial fluid cultures compared with synovial fluid culture alone (86% [95% CI 70 to 95] versus 79% [95% CI 68 to 87]; p = 0.36); when stratified by site, no difference in hip and knee infections was observed (86% [95% CI 67 to 96] versus 77% [95% CI 63 to 88]; p = 0.42) and 86% [95% CI 70 to 95] versus 80% [95% CI 64 to 91]; p = 0.74). CONCLUSION SASA measurement improves the predictive value of synovial fluid cultures of the hip for all staphylococcal organisms, including coagulase-negative staphylococci, but the PPV of SASA plus synovial fluid culture it is not superior to the PPV of synovial fluid cell count/differential plus synovial culture for the knee. LEVEL OF EVIDENCE Level III, diagnostic study.
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Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count. J Clin Med 2020; 9:jcm9103349. [PMID: 33081071 PMCID: PMC7603093 DOI: 10.3390/jcm9103349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. METHODS We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/-10 years, and time of aspiration (+/-2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. RESULTS In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). CONCLUSION MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.
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Pinnacle Ultamet metal-on-metal total hip arthroplasty survivorship: average 10-year follow-up. Arthroplast Today 2020; 6:596-600.e1. [PMID: 32995407 PMCID: PMC7502581 DOI: 10.1016/j.artd.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/10/2020] [Accepted: 02/15/2020] [Indexed: 11/22/2022] Open
Abstract
Background It is unclear whether a connection exists between femoral head size, offset, neck length, and cup abduction angles, and rate of revision in metal-on-metal (MoM) total hip arthroplasty (THA) implant systems. Methods A retrospective review of MoM THA completed by a single surgeon with a single implant between 2003 and 2008 was conducted. Patient demographics, implant data, radiographs, and revision details were collected at follow-up. Incidence rates for revision and osteolysis were calculated in regard to the femoral head size, stem offset, neck length, and cup abduction angles. Results Six hundred and ninety two THAs were identified, with 79% of patients returning for a median follow-up of 10.3 years (interquartile range = 6.0-12.3). The median time to revision was 7.5 years (interquartile range = 5.3-9.9) among 27 total revision surgeries. The overall incidence rate of revision was 5.4 revisions per 1000 person-years, 3.0 revisions per 1000 person-years for adverse local tissue reaction. Hips with a cup abduction angle of ≤40° had revisions at nearly twice the rate of those with an angle of 41°-50° (incidence rate ratio = 1.98, 95% confidence interval: 0.92, 4.29). Hips with a 9 mm neck length had an increased rate of revision (incidence rate ratio = 5.94, 95% confidence interval: 1.33, 26.55) relative to those with a neck length of 0 mm. Rates of osteolysis were similar between implants of different head sizes, neck lengths and cup abduction angles. Conclusions MoM implant systems with longer necks and smaller cup abduction angles may lead to increased need for revision. Results from this study suggest a need for closer long-term follow-up of MoM THA systems.
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Reiner T, Haubenreisser H, Tripel E, Rosshirt N, Sorbi R, Nees TA, Gotterbarm T, Merle C, Moradi B, Hagmann S. Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up. J Clin Med 2020; 9:jcm9092877. [PMID: 32899901 PMCID: PMC7564376 DOI: 10.3390/jcm9092877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
(1) Background: The objective of the present study was to investigate peripheral blood lymphocyte subpopulations in patients with small diameter metal-on-metal total hip arthroplasty (MoM THA) and elevated blood metal ion concentrations at long-term follow-up. The hypothesis was that increased blood metal ion levels or the presence of adverse local tissue reactions (ALTR) would be associated with changes in the peripheral expression of lymphocyte subpopulations, which could potentially serve as early diagnostic markers for metal wear related complications. (2) Methods: Peripheral blood samples were analyzed for leucocyte subgroups (CD3+, CD4+, CD8+, CD14+, CD16+/CD56+, CD25+/CD127−, CD19+, IFN-γ+, IL-4+ and IL-17A+ cells) in 34 patients with elevated blood metal ion levels (combined cobalt and chromium levels >2 µg/L) following small head MoM THA at a mean follow-up of 15.6 years. Fifteen patients with small head MoM THA and blood metal ion levels within the normal range and 15 patients with conventional ceramic-on-polyethylene THA served as control groups. In addition, blood metal ion levels and leucocyte subpopulations were compared between patients with and without adverse local tissue reactions (ALTR), which was investigated by MRI in 27 patients of the study cohort. (3) Results: There was a significant decrease in the levels of IFN-γ+ Type-1 T helper cells (Th1) in patients with MoM THA compared to the ceramic-on-polyethylene control group (p < 0.001). No statistically significant differences in the cell counts of other lymphocyte subpopulations were found between the three groups. Cobalt ion levels were significantly higher in patients with ALTR (p < 0.001) compared to the non-ALTR group, but no differences in the levels of lymphocyte subsets were found between the two groups. (4) Conclusions: No adverse systemic effects with respect to peripheral blood leucocyte subpopulations could be detected in the present study in patients following THA with a small diameter MoM articulation at long-term follow-up. We found a significant decrease of IFN-γ+ Th1 cells in patients with MoM THA compared to the control group, but no differences in the peripheral expression of leucocyte subpopulations were seen between patients with and without ALTR. Future studies with larger patient cohorts and additional histopathological investigations could help to better understand the role of Th1 cells and other cell lines of the adaptive immune system in the development of metal wear related complications after total joint replacement.
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Affiliation(s)
- Tobias Reiner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
- Correspondence: (T.R.); (S.H.); Tel.: +49-6221-5634803 (T.R.); +49-6221-5626289 (S.H.); Fax: +49-6221-5626179 (T.R.); +49-6221-5626348 (S.H.)
| | - Hester Haubenreisser
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Elena Tripel
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Nils Rosshirt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Reza Sorbi
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Timo Albert Nees
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, 4020 Linz, Austria;
| | - Christian Merle
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Babak Moradi
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Sébastien Hagmann
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
- Correspondence: (T.R.); (S.H.); Tel.: +49-6221-5634803 (T.R.); +49-6221-5626289 (S.H.); Fax: +49-6221-5626179 (T.R.); +49-6221-5626348 (S.H.)
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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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Remya AR, Vishwash B, Lee C, Pai PS, Espinoza Oras AA, Ozevin D, Mathew MT. Hip implant performance prediction by acoustic emission techniques: a review. Med Biol Eng Comput 2020; 58:1637-1650. [PMID: 32533510 DOI: 10.1007/s11517-020-02202-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
Nowadays, acoustic emission (AE) has its applications in various areas, including mechanical, civil, underwater acoustics, and biomedical engineering. It is a non-destructive evaluation (NDE) and a non-intrusive method to detect active damage mechanisms such as crack growth, delamination, and processes such as friction, continuous wear, etc. The application of AE in orthopedics, especially in hip implant monitoring, is an emerging research field. This article presents a thorough literature review associated with the implementation of acoustic emission as a diagnostic tool for total hip replacement (THR) implants. Structural health monitoring of an implant via acoustic emission and vibration analysis is an evolving research area in the field of biomedical engineering. A review of the literature reveals a lack of reliable, non-invasive, and non-traumatic early warning methods to evaluate implant loosening that can help to identify patients at risk for osteolysis prior to implant failure. Developing an intelligent acoustic emission technique with excellent condition monitoring capabilities will be an achievement of great importance that fills the gaps or drawbacks associated with osteolysis/implant failure. Graphical abstract.
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Affiliation(s)
- Ampadi R Remya
- Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
| | - B Vishwash
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Mechanical Engineering, NMAM Institute of Technology, Nitte, Karnataka, 574110, India
| | - Christine Lee
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Bioengineering, University of Illinois, Chicago, IL, USA
| | - P Srinivasa Pai
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Mechanical Engineering, NMAM Institute of Technology, Nitte, Karnataka, 574110, India
| | - Alejandro A Espinoza Oras
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Didem Ozevin
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mathew T Mathew
- Department of Biomedical Science, UIC School of Medicine, Rockford, IL, USA.
- Department of Material Science and Civil Engineering, University of Illinois, Chicago, IL, USA.
- Department of Bioengineering, University of Illinois, Chicago, IL, USA.
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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How Useful Is Magnetic Resonance Imaging in Evaluating Adverse Local Tissue Reaction? J Arthroplasty 2020; 35:S63-S67. [PMID: 32005623 PMCID: PMC7239755 DOI: 10.1016/j.arth.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 02/01/2023] Open
Abstract
Biologic failures of hip arthroplasty have emerged as an increasing threat to the longevity of the prosthesis. While wear of modern-day bearings has been greatly reduced with the advent of cross-linked polyethylene, local reaction to metal particles either from the bearing itself or to any of the modular tapers appears to be on the rise. Monitoring of these reactions by the use of plain radiographs or serum markers appears to be insufficient to gauge the gravity of the response. Over the past decade, the use of magnetic resonance imaging (MRI) techniques has emerged as the superior noninvasive instrument to assess the extent of soft tissue reaction around hip implants. The use of MRI around implants was initially challenging due to the presence of relatively high ferrous metals especially cobalt which causes local distortion of the magnetic fields. Novel changes in pulse sequencing have greatly improved the sensitivity and specificity of MRI so that at this time, MR is the most predictive diagnostic tool in evaluating the extent of tissue destruction. We feel strongly that modern MRI techniques are the most important tool in the workup of the patient suspected of having an adverse tissue reaction after hip arthroplasty.
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Abstract
BACKGROUND Modern total hip arthroplasty has seen an unfortunate increase in proportional implant failures secondary to adverse local tissue reactions (ALTRs) secondary to wear of metal-on-metal (MoM) bearings and mechanically assisted crevice corrosion (MACC) related to corrosion at implant junctions and tapers. The purpose of this study is to describe the appropriate choice of metal ion testing and evaluation of those levels to identify failed total hip arthroplasty implants containing cobalt and chromium. METHODS When presented with an arthroplasty of concern, the surgeon must determine what metal ion levels to obtain and then incorporate those levels into a treatment algorithm. Patients with painful hip arthroplasties are evaluated for chromium and cobalt by obtaining whole blood and synovial metal levels. RESULTS Synovial fluid cobalt had the highest correlation with ALTR compared with the other tests, with a threshold of 19.75 ng/ml, with a specificity of 89%, if the cobalt-to-chromium ratio is greater than 1.4 ng/ml in a metal on polyethylene hip, with a sensitivity of 95%. CONCLUSION The interpretation of whole blood metal ions is a key component of the algorithm in treating the symptomatic hip arthroplasty but is not to be used in a vacuum.
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Metal-on-Metal Total Hip Revisions: Pearls and Pitfalls. J Arthroplasty 2020; 35:S68-S72. [PMID: 32081501 DOI: 10.1016/j.arth.2020.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
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Comparison of Harris Hip Scores and Revision Rates in Metal-on-Metal Versus Non-Metal-on-Metal Total Hip Arthroplasty. J Am Acad Orthop Surg 2020; 28:e422-e426. [PMID: 31415300 DOI: 10.5435/jaaos-d-19-00251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients. METHODS A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS). Patients requiring a revision arthroplasty were not included in the HHS analysis. RESULTS A total of 49 patients had MoM implants (65.3%), and 26 patients had non-MoM implants (34.8%). At a mean follow-up of 7.6 years, 10.2% (5/49) of MoM prostheses required revision, whereas 3.8% (1/26) of non-MoM prostheses required revision (P = 0.334). The mean HHS in the MoM cohort was 89.8, compared with 88.1 in the non-MoM cohort (P = 0.69). CONCLUSION HHSs were not notably different between cohorts. The MoM cohort had three times as many revisions as the non-MoM cohort, but given the numbers available, this difference did not reach significance. Given the clinical importance of these revision data, further study is warranted to determine survivorship of the MoM versus non-MoM total hip arthroplasty at long-term follow-up.
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Labban J, Letissier H, Mertl P, Lefèvre C, Migaud H, Clavé A. The Lefèvre retentive cup compared with the dual mobility cup in total hip arthroplasty revision for dislocation. INTERNATIONAL ORTHOPAEDICS 2020; 44:1661-1667. [DOI: 10.1007/s00264-020-04601-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
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A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants. J Patient Saf 2020; 15:97-104. [PMID: 26076080 PMCID: PMC6553976 DOI: 10.1097/pts.0000000000000220] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives We sought to synthesize data on systemic arthroprosthetic cobaltism, a recently described syndrome that results from wear or corrosion of chrome-cobalt hip components. Methods We conducted a systematic literature review to identify all reported cases of systemic arthroprosthetic cobaltism. To assess the epidemiologic link between blood cobalt levels (B[Co]), we developed a symptom scoring tool that evaluated 9 different symptom categories and a category of medical utilization. Results We identified 25 patients reported between 2001 and 2014 with a substantial increase in case reports over the past 3 years. Symptoms were diverse and involved the hip (84%), cardiovascular system (60%), audiovestibular system (52%), peripheral motor-sensory system (48%), thyroid (48%), psychological functioning (32%), visual system (32%), and the hematological, oncological, or immune system (20%). The mean latency from implantation to presentation or revision was 41 months (range, 9–99 months). The mean B[Co] was 324 μg/L and 4 patients had levels less than 20 μg/L. The B[Co] but not blood chromium level was highly associated with a quantitative measure of overall symptom severity (r2, 0.81; P < 0.001). Mean B[Co] and symptom scores were substantially higher in patients with revisions of failed ceramic-on-ceramic prostheses than those with primary metal-on-metal prostheses. Conclusions Systemic arthroprosthetic cobaltism is an increasingly recognized complication of wear or corrosion of chrome-cobalt hip implants, may involve a large number of organ systems, and may occur with relatively low B[Co]. There is an urgent need to better define the overall scope of the problem and to develop screening and management strategies.
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